Well it truly is my last day in Uganda today.  It has been just like any other day and that I am returning to the cold wet UK tomorrow doesn’t seem real somehow.

My return journey began at 6.00am yesterday after 3 hours sleep.  Nights are lOUD in Uganda.  The hospital holds outreach clinics around Uganda and I was lucky enough to travel with the team to the clinic in Kampala, nicely rounding off my trip.  There were a number of patients at the clinic who were attending follow up appointments. including some children with very big heads, I think it is likely that they have been with the hospital for some time.

I I spent the afternoon exploring the Kampala.  The government buildings would be quite impressive if not behind solid metal sheets which were erected around the perimeter.  The city seemed as manic as when I arrived, with cars and other vehicles everywhere. After a few hours my lungs had had their fill of dust and pollution and I headed back to the hotel for a swim and a debrief meeting on my experiences in Uganda.

After waking to a torrent of rain and seeing the roads turn into rivers of muddy water I travelled to Entebbe.  Entebbe used to be the capital and is only just outside Kampala, the traffic means the journey can easily take an hour.  I was staying in the north of Kampala in an area with wide streets and grand structures.  To the south of the city there is a much different feel, there are the open air markets that I am used to, with rickety stalls crammed together and the mud brick houses which have sprung up to create slum areas. There are a lot of people living in this part of the city.

As it had brightened up I headed to the Botanical Gardens which grace the edges of Lake Victoria.  The gardens were like a large park – groups of school children splashing about on the shores of the lake, lots of trees and many birds flying around; I also managed to spot some Columbus monkeys in a tree. A good way to end the day. 

Early flight tomorrow, just hoping it leaves on time........

Tunalabagana

Well, final day today..I have been very excited this week, looking forward to returning home.

Yesterday I had a surprise, the hospital arranged a leaving party for me and a nurse who is leaving to train to be a medic.  Frequent readers may recall the party we had for Viola last month.  There were some speeches of thanks and the chance for people to say why they had enjoyed working with those leaving.  This was accompanied by a boiled egg, samosa, banana, cake and bottle of pop.  It was a great surprise and a lovely way to round off my stay.

saying thanks (accompanied by a lot of
arm waving)

party fare

The hospital has an outreach clinic in Kampala tomorrow so I will be travelling with them. I plan to explore the city and also visit the Botanical Garden in Entebbe before my flight home Sunday.

me hard at work in my armchair

Well, where to begin...

Took a trip to Murchison Falls National Park this weekend, it is situated in Western Uganda near the border with the Democratic Republic of Congo.  The park is made up of 2000 miles2 of rainforest, woodland, savannah and wetlands, with the Nile flowing through it.  The park is a designated conservation area although locals are not allowed to live in the park they are able to fish on the Nile.

Set off early Friday morning – taking a short cut through the countryside to avoid Kampala and reduce the travel time (9hrs).  Although the road was pretty bad it was good to see parts of the country I haven’t seen before and the road cut up through central Uganda.  The roads are very straight and very long – disappearing off into the distance and seeming neverending.  I was reminded of a book I’d read earlier this year about the Congo – how, if you put a stick in the ground it will grow into a tree.  There were often trees and small bushes sprouting up at the edge of the road.  It is  such a fertile country that it is easy to imagine that with no passing traffic or maintenance the roads would disappear in a year; as if they had never existed. 

 

As we’d left pretty early we saw lots of children on their way to school.  Along the road side there were long streams of brightly dressed children of all ages walking alone or in small groups, some with books, some without, some with shoes, some without and those that were a bit late scurrying along at a faster pace.  Some children remain at home with their parents who decide not to send their children off to school, particularly if they themselves didn’t attend; instead the children work in the fields.  The driver was telling me that there are very few text books in the schools and children have to provide their own workbooks.  Not all families can afford to buy the necessary supplies and so some children can leave primary school without being able to write their names.

I’ve mentioned previously every home seems to have at least a cow and a goat, in Western Uganda Ankole cattle are a popular breed. Their horns are HUGE, not to be messed with!  I saw many of these.

During the drive I also spotted a pair of red tailed monkeys swinging from some trees.  Also a HUGE Marabou stork – I don’t think I’ve ever seen such a large bird flying overhead – but goodness was it ugly!

Had lunch in a town called Masindi were I caught the news about the miners trapped in the mine in S Wales. 

Stopped off en route to the park to see some white rhinos.  The authorities in Uganda have set up an enclosed sanctuary of 70km2 to encourage breeding with the hope of returning white rhino back into the wild in the future. I was expecting them to be fenced off – but no, how wrong I was.  Instead I found myself standing about 15m away from a mother and two baby rhinos.....I had earmarked the trees I would head for if they charged!!  The rhinos roam around the sanctuary looking for tasty grass - apparently they have favouite types.  There are currently 10 rhinos in the park soon to be 12 (one of the male rhinos has been very busy).



Bella and Augustu




Obama



Arrived at the NP late afternoon to a be greeted by a rainstorm, luckily it soon stopped so we could head to see the top of the Murchsion Falls where the Nile squeezes through a small gap to crash down some 50m.   The falls were great from the top – the river was wide and very powerful – there was a lot of spray so I had a very good cooling off!!  The fall was much more powerful than those at Jinja and Sipi. Many baboons and a mud bath of buffalo greeted us on the way to the lodge.




mud glorious mud

 

The Falls



Accommodation was great with the luxury of walking around bare foot and turning on a tap to have water running out!  Food was also very nice and had my first glass of wine in 7 weeks.  All rooms had balconies facing the Nile and the entrances to the rooms was via an open walkway – getting to and from the dining room meant running the gauntlet along the walkway dodging the many flying bats!  I know they are supposed to know you are there but I did have my doubts at times – anyone watching me walking along ducking and diving would have found it hilarious.

Have finally discovered what the blue and white nets are for that I see hanging from trees – they look like abandoned kites but are for trapping tsetse flies which can cause sleeping sickness.  Our van was bombarded with these flies at one point – it felt like one of those thriller movies with mad bees.

Saturday started with a game safari – taking the advice of the driver we had an early start, 6.00am we were the first ones out.  I wasn’t really all that bothered about this part of the trip – how wrong was I, it was great fun!  The roof of the van lifted up and as I was on my own I had a 360 view.  Perfect.  We set off in the dark and about 20 mins later two giraffes loomed out from the side of the road.  We were so close I could hear them breathing.  They were less fussed, and after a few minutes, trotted off.  Throughout the morning I ended up seeing lots of giraffes.  They seemed to run in slow motion which was quite strange to see.  Saw lots of different antelopes, giraffes, a few warthogs, lots of birds, a Patas monkey and many hippos in the hippo pool.  The landscape changed a lot throughout the drive and so did the smells.  The animals mark their territories, I can assure you some smell a lot nicer than others.  

larking about

However we were the early birds that caught the worm.  We had tried to pass down a road but got stuck in the mud trying to turn; in the end the driver got us out of the mud and we looped around a different way through the park.  Turning a bend, there in the middle of the road blocking our path was a pride of lions.  Two cubs and a mother just in front of our van with two young adults and the male further down the road.  If our original route hadn’t been foiled by the mud we would have seen the male lion first and not had such a good view of the mother and cubs. 

What luck – it was great watching the cubs lark about.  After about 15mins they sloped off to a nearby bush and the male started walking towards us before moving away.  We were the only ones to see this sight, other vans were arriving as we were departing, my driver having a lot of kudos from other drivers for his find!

Later in the day I took a boat cruise up the Nile to the foot of the falls.  I saw many more hippos – their heads would suddenly pop out of the river.   They are warm blooded and also easily sunburnt so keep cool in the water, often submerging themselves for 5 or 6 minutes at a time. Managed to also see some speedy Nile crocodiles – one second on the bank the next they’ve disappeared into the water.

Yesterday I went chimp trekking in the rainforest and spotted two male chimps up a tree grooming each other.  They were very meticulous and were making a very thorough job of it, also being very human like in some of their movements.  On the way back the floor of the forest began moving – a swarm of Army ants.  One of the critters got into my shoe; I can confirm that it has a sharp bite! Another stuck on my trousers was also having a good nip. 

As you may expect there were many different types of tree in the rainforest including a 600 year old Mahogany tree.  It was so big I couldn’t even see the top of it, and apparently it takes 12 people handling hands to circle it's trunk.



Me and the Mahogany





lunch in the bush on the way home



Final week this week, I’m hoping to explore Kampala and get in a visit to the Botanical Gardens before I fly out next Sunday.

I would really like a pet African goat.  They are very cute.  They also seem to be fairly docile. Outside the towns at least every home seems to have at least one goat, and they are often to be seen along the edges of the road munching and playing.  However, some have unusal ways of getting about.  A few weeks ago I saw a goat wrapped around the waist of a boda boda (motorbike) driver - a bit like a belt. It was hanging on in there perfectly quietly!  Last weekend, on my way back from Jinja, I saw a goat sittng on the lap of a girl who was having a lift on the back of a bicycle - the goat was lying perfectly still and was very well behaved!  The idea that their milk could be used to make cheese is usually greated by whoops of laughter.  Mind you, cheese here is pretty grim so no wonder people find it strange that I like cheese very much.

I've mentioned African birds in much earlier posts. Whilst having lunch yesterday I noticed a streak of blue flying across the gardens.  This is the fellow reponsible - the flash of blue increases when it opens its wings.  As you can see it was also raining!

Staff here found taking a photo of a bird very strange!  Photos are usually only taken of people.  There's limited interest in wildlife, I'm not very good on birds but can name the common everyday ones - no one has been able to tell me the name of any bird yet when I've asked. 

Talking of unnamed creatures - the weird creature that featured in a recent post (the one that lives under a drain cover) remains unnamed.  I have tried to discover more about them but failed - I did poke one with a twig to see what what happen, but, predictably I suppose, it scuttled off home.

I've mentioned the lizard who lives in the window a few times. The lizard has acquired a partner - I thought I would share a photo of them. There's usually at least one of them hanging about.  My bed is under the window so I can often hear them scuttling about.  When it's quiet that is.  I don't think 'noise pollution' as a concept exists here.  Last night there was a combination of 80s cheesy music, thudding base overlaid with arabic prayers.  The music was still going strong at midnight, at the weekend it's still playing when I wake up.

I discovered this week that people can be given whatever names a parent chooses - for both first and last names.  There doesn't have to be a family name that is used for each member of the family and passed through generations.  Sometimes children that come to the hospital are given very negative names, with meanings like 'cursed' or 'death'.  This is due to the perception of the parents of the child's condition.  At the hospital the parents are often encouraged to change such names to ones with more positive meanings.  It is also possible to go through life without your birth being registered. If you are not registered at birth you can register yourself later in life if needed.

Coming up to my last week in work now so trying to tie up loose ends and get things ready to handover....

Looks like the rain clouds are looming in over the mountains...however it is currently very warm with a very slight cooling breeze, so I sit in the guest house garden to write this update.  A strange creature is flying around the garden sounding like those wooden blocks that are whirred around on a stick (I have no idea what they are called - neither the blocks nor the flying beastie).  For a small thing it's making a heck of a racket.

Another Indian last Friday - and I met some more ex-pats. A pleasant way to round off the week, and my last working Friday in Uganda.

I've been battling the banks for the last few days to try to withdraw sufficient funds to pay for my forthcoming trip.  I have now discovered it's all a total gamble, it is impossible to tell how much can be withdrawn on any one day.  One day it is possible to withdraw UGX 1m (approx £230) the next day the limit is UGX 400,000.  On Saturday, having amassed sufficient funds and with a bulging money belt I set off for Jinja to pay for my trip.  The only other method to pay for the trip was a money transfer which would have taken too long.  This is very much a cash economy although I did discover recently 'mobile money' where money can be sent/transfered/retrieved via the mobile phone. 

The banking system here is still fairly basic.  Not everyone has a bank account and apparently the banks are not linked together - so you can go from one ATM to another re-drawing your daily limit.  We got on to the subject of banking matters during our Friday Indian. When one person lost their card the details of the loss were logged in a book (rather than being recorded on the electronic system). Another waited only 10 mins for a new card to be produced - along with a slightly different name!  I think this is banking African style.

I thought I would try to get a bus to Jinja after my experience last time in the minibus taxis.  I managed to get a seat on a bright yellow and red bus.  The bonus was that I had a seat to myself; albeit rather a narrow one.  As we travelled along I got a better view of the things that I had seen last time as I was much higher up. It was also a lot faster because there was less stopping to drop people off and squeeze more people in.  It only took 1.5hrs. One of the towns that we passed,  Namutumba, was twinned with Ross-on-Wye!

Spent a few hours pootling around Jinja and handing over the bundles of notes, then after a bit of sustinance (Spanish omelette - listed under 'African food) I decided to head back.  The buses hurtling past the bus stop didn't bother stopping as they were full of passengers travelling from Kampala. So a minibus taxi it was to be.  There were lots of children in the bus - even though there were some small babies they were all very quiet.  I turned around at one point to discover a woman sitting behind me with a child clamped on to each breast. It was almost as if children were treated like bits of luggage. For part of the journey I had a little girl wedged between me and the woman sitting next to me - her nose almost pressed against the seat in front; her mother sitting in a row further behind following a reshuffle.  Children were lifted on and off the vehicle by someone grabbing one arm  - a bit like you might lift a cat by the scruff of the neck.  We nearly drove off without one girl at one point. 

There were also a few kerfuffles.  One very smart lady scuffling to get on the bus in one town pushing back a couple of men - I don't know if she beat the men to the seat or whether they were trying to stop her getting on - they were trying to pull her off - but she soon sorted them out - the door was closed with a snap and we were off.  20m further down the road and we stopped to take onboard another woman and child - after they were on the two men that were with her also kicked off and ripped the shirt of the boy who sorts out the passengers.  There must have been something up with the men in that town.....

In the middle of nowhere we stopped to let one woman and her husband off - then we heard some loud whooping and screaming and a woman running across the field - I think she was definitely pleased to see her visitors, the whole bus was laughing at her excitement.

After one bout of reshuffling the driver tried to drive off whilst I was half out of the minibus and the door slammed into my shoulder - I didn't know what was going on!  3 hours later I was glad to finally get off - in one piece, but absolutely filthy (never wear white).  A beer and a shower soon sorted me out though.

Have had to retreat indoors as the rain has started - big fat splots coming down thick and fast.  This time in 2 weeks I should be somewhere in the air  - heading back to a lot more rain by the sound of reports!

It's official.  I am fed up with bugs.

Last night I discovered a bug burrowing in my PJs (thankfully before I put them on).  This morning there was a cockroach on the bathroom floor - lying with it's legs in the air (not dead I discovered when I went to pick it up) and now I've just discovered a pile of bites halfway up my leg - how did they get there??? Mosquitos don't munch through thick trousers, what's going on?

However, there is one 'bug' that has been intriging me.  I managed to get some snaps of it today.  It is a shy little thing.  It lives under a drain cover at the front of the guest house.

two here, one next to the pipe the other by the corner of the cover



bit more of a close up - here one is scuttling for the safety of the drain cover, other by the pipe



They are so wierd - they look a bit like bees with a load of twiggy fluff on their backs.  I wondered if it was some sort of spider - but no, apparently not.  Although I'm told they are not spiders no one can tell me what they are.  So, suggestions please.............................................

You may recall a few weeks ago I was a bit anxious that I may wake up being flattened by a water butt...well the building work has now finished.  The day started at 6.45 with two loud maintenance men bellowing directly outside my window.  After I'd hauled myself out of bed I could witness the big vast tank being 'rolled' towards the store.  Anyway, some people have been busy today - a tank is now in place, see below - please also appreciate the wooden structure built to help get it up there....



I think tank no 2 will be on the schedule for tomorrow!

Lab & edge of outpatients

I thought I would share some photos of the hospital and update on the latest hospital dramas.  There's always something going on around here - although often the stories are tinged with tragedy.

Mondays are usually the busiest day of the week for dealing with patients.  This Monday was almost unprecendented - over 50 patients turned up at outpatients - some new, some for follow-up appointments.  Usually there's around 30 patients on a Monday - so almost double this week.  We had a lot of rain Monday and at one point many of those waiting had to be brought inside the building - I think it must have been very cosy!!!Some of them ended up having to stay overnight to be dealt with on Tuesday.  By contrast there has only been 10 patients in today.


The eating area and some grounds


We were busy working away in the server room office yesterday when we were startled by loud shrieking and wailing outside.  The chaps jumped to see what was going on -  a woman being restrained outside the ward.  About 5 mins later  we could hear her running along the walkway still shrieking.  It turns out the medics were trying to sedate her it seems she thought people wanted to kill her and eat her!  She was very distressed - probably more so with people gathering around her trying to catch her!

I have mentioned that we have a new guest that arrived at the end of last week - he's been in at the deep end in the early part of the week as he spent Monday assessing patients in out patients, seeing one which had some brain matter coming out of his skull (?!?!), Tuesday, he was about to assess a follow-up patient when the mother started becoming distraught - saying that her baby had died.  When he checked he discovered that this was indeed the case and  unfortunately the baby had passed away. A brain tumour.


not the best photo I know - it was early Sunday morning!
 - operating block in background,
path up to the lab along centre

 Both women were taken home by the hospital.  The one that was afraid of being eaten luckily grew calmer as she approached her home.  Hopefully another member of the family will bring the child back for treatment. 

All in a day's work in the life of a hospital worker..............

It's been a busy few days.

I decided to go to devotions on Friday morning, the majority of staff in the hospital attend - there are prayers in one form or another everyday.  Being located next to the spritiual centre I often hear the signing and drums every Wednesday and Friday. Everyone comes back to work quite happy so I thought I'd see what it was all about.  I turned up halfway through - just as the HR manager began his sermon(?)  Although based on passages in the Bible I thought that there was very much an HR/people theme.  It was essentially a bit of a pep talk about people having a vision (not necessarily a prophetic one), improving and challenging themselves and making the most of opportunites. Quite relevant!

Friday afternoon was the staff meeting where I presented the findings of my information mapping work and suggested some recommendations.  It was difficult to judge how it went, there was some discussion and some actions were agreed.  Now to help get as many of the actions progressed as far as possible before I leave in a few weeks.

Friday evening I met up with some Brits and an American and went for an Indian in Delicious Dishes.  Very delicious it was too, especially the paneer.  I am a cheese addict going through cold turkey at the moment so lots of paneer was ideal.  I also got to see Mbale town at night time - it was very busy with lots of people coming, going and hanging around.

A new guest has arrived at the house; the sixth housemate since my arrival. I showed him around the town in the morning.  In the afternoon we went swimming with one of the doctors from the hospital and his wife.  The pool was attached to a hotel where there were two weddings taking place. A marching band tromped past soon after we'd started swimming - that was good to see and hear.  The two bridal parties also had photos taken by the pool (with people splashing about in the background in their swimming costumes!!).  The brides had the usual white dresses, veils etc with brightly dressed bridesmaids.  Many of the women guests were dressed in the traditional dresses with the pointy shoulders. V smart outfits.


On Sunday we took a trip to Sipi Falls which is in the Mount Elgon national park. The park crosses over into neighbouring Kenya. Part of the mountainous area is visible from Mbale where I am staying.  Sipi was about 60km away along an amazingly good road. Someone told me that before it was resurfaced (or should that just be surfaced) it used to take a whole day to travel between the towns!!!

I've mentioned before about landslides in the mountains, there had previously been one across the road we'd travelled on - some small slips were also visible as we were walking around the falls area.  The area was very beautiful - green and bushy with lots of different trees etc.  There are 3 falls - we started with the 2nd one - my favourite, we then tromped up the mountain to look for the 3rd one.  I must say, living in Wales is good practice for steep muddy moutains!!



Coffee trees



On reaching the top of the 2nd waterfall we found local villagers washing their laundry at the edge of the falls with children playing close by.  A group of young boys acted as guides and showed us the way to the 3rd fall.  We walked through peoples plots and saw their homes and all the things that were being grown. Also saw coffee trees for the first time - including the sappy beans which are picked, split and then washed in the river.  These are then laid out to dry and roasted.  These are taken to the big coffee markets where they are sold to producers - and then end up in your coffee cups!  In addition to the crops every home seemed to have at least one goat and cow tied up in the yard.  There were also often plenty of chickens running about.

Photos are in no particular order and moving them about is a big faff, so just enjoy

 

Top of the 2nd fall - aka laundrette



approaching 3rd fall past plenty of banana trees

  





heading back up from the first falls - spot me in the middle lagging behind at this point!





   

Arriving at the falls - view from car park

Behind 2nd watefall - a bit wet!!



sea of cabbages.....


 After climbing back down from the 3rd falls to the car park where we started we had some much needed lunch!! A Ugandan style buffet - pasta, rice, cabbage, goat, pork, peanut sauce (mmm), peanut sauce with bitter tomatoes, chapattis and so on. Refuel over and we mooched along the road to the final fall (aka the 1st fall).  It wasn't possible to see the fall from the start and despite lunch energy levels were flagging.  Still - no point going all that way and wimping out at the last moment.  So we slid, scampered, climbed and trotted down the mountains stopping on the way down to have a run in with people who wanted us to pay again.  These falls had a drop of 90 odd meters - the others were slightly less.  I can't say I was relishing the climb back up - but evetually made it.  Approaching this fall was quite different to the others as we had to climb down into a valley - it was possible to get a good view and see how the fields were planned and the different types of produce planted.  On the way back up we met quite a few locals who were coming down with large, heavy looking bags balanced on their heads.  Quite a feat with many years of training I think.  The paths carved into the side of the valley were only one foot wide - a few times I wondered what would happen with one small slip...... (probably end up in a maize/sweetcorn crop part way down the mountain).  Got back very dirty and very tired but had a great day out.





At the 1st waterfall





Village homes and gardens between 2nd and 3rd falls




view across the valley of the differently planted plots - 1st falls



Short update today.
Just been looking at the BBC news online - it featured the Zimbabwe circumcision story that I mentioned in my last update.  A bit of a different story reported by the BBC, it said that the Deputy PM had called on members to have the procedure - and that a number of (male) MPs are not keen.  It turns out that the Deputy PM is a woman!  ha ha ha

Further update to last blog.  Have also discovered why chickens seem so docile and don't run around causing havoc - their legs are tied together.  Simple.

Another hospital drama here today. Third so far.  It's the same the world over I think, you hear a bit of a story, then a bit more, then something else and it takes on a life of its own.  However unfortunately the drama seems to have got more serious as the day has progressed.  I warn you in advance, it's not a nice situation - but then dramas here rarely are, but gives an idea of what life can be like for people here and the challenges they face.  A woman and her new born were admitted to hospital a couple of days ago and the baby was successfully operated on yesterday (spina bifida - for those who don't know much about it, it's a birth defect where the backbone and spinal canal don't fuse properly - often there is a lump on the spine with an open wound - there can be some strong reactions to this in communities - blaming the mother for being bad, or unfaithful to her husband or saying that the baby is possessed by an evil spirit). The drama this morning was that the mother had abandonned the baby and tried to escape from the hospital.  She was caught, brought back and was couselled.  This afternoon a second escape attempt was made (again leaving the baby) - I think her husband also turned up - this time she tried to climb over the fence.  No small feat, it is quite high - metal - covered mostly by bushes, she must have scratched herself quite a bit.  In the end she was discharged with the child.  The mother was obviously distressed and must have been in a lot of anguish.  This all rippled through the hospital - it is small enough for people to have an idea that something is going on and word soon gets about.  Unfortunately, the situation appears to be even more serious, the baby is HIV+, so the mother is too - she wasn't previously aware; she also tried to throw herself under a car during this morning's escape.  What an absolutely tragic situation.

On another note, public sector workers worried about their pensions should be glad they are not working in Uganda. It has been reported that the President would like to 'borrow' some money -300bn shillings - (£1=Ssh4800) from their pension savings to pay for a new parliament chamber.........

Well it has rained and rained since the weekend, some say they haven't seen rain like if for some time.  Unfortunately around some parts of Mount Elgon the rain has had disasterous effects.


view from indoors!

 A mudslide has occurred in the Bulambuli district, at least 26 people have been killed and 22 houses are buried.  There was a terrible picture in the paper of a woman up to her knees in mud trying to dig with her bare hands as her children had been buried by the slide.  Earlier this year there was a similar event but killing 350 people.   Much of this is believed to be due to deforestation and encroachment, the chopping down of trees has left land subject to landslides and people are setting up home on high slopes.  Apparently the government was warned of a looming landslide and failed to act until after the event.  But not to worry, Cabinet has approved a policy on 'disaster' which is awaiting implementation (!!)


I suspect that there has also been floods in some areas and that many roads have become impassable as they've turned to mud. Maybe this is covered by the disaster policy too.......

Many crops are also being destroyed by the rains - this will have a big impact on those who rely on crops for their livelihoods and will also mean that there is less food available in local markets.

I ran the gauntlet of the local market today.  It's a pubic holiday today to celebrate the end of Ramadan; there were many people dressed up in their finery all around the town, the women were very colourful and the men were mostly dressed in white (I wish I knew their secret for bright whites - mine are all turning brown).  The market was fairly busy - loads of chickens which are fairly docile (which is why I always think they are dead)- I'm not sure why they don't run around causing havoc, some were in cages but most were just dumped in the car parking area.  Will need to try to find out.  I also realised at one point that I had a load of street kids tailing me - I felt like the Pied Piper!

A number of people have asked me about food.  I think it's quite well established by now that I mostly eat rice and beans.  However it is possible to buy most things in the shops so I tend to eat similar sorts of things that I might have at home.  There's a smaller range of fruit and veg because everything is seasonal - the quality is also variable so it pays to shop around a bit.  But I've discovered a Cadbury's coconut and cashew choc bar is very tasty!!

Unusual article in the newspaer today - Zimbabwe has done a lot to reduce HIV transmission rates and has seen some good results.  It seems a South African study has shown that circumcision reduces the risk of transmitting HIV by 60% - so the Cabinet Ministers in Zimbabwe have decided all men should be circumcised and that they will lead the way setting an example!!  Mind you I think this could be counter productive as people may think it's safer and take less precautions....

Well it is supposed to be rainy season.....it started raining about 2.30 yesterday and is still going strong with a short respite this morning timed nicely for the 5 min walk to work.  It was raining so hard at one point yesterday it felt as if a river was pouring out of the sky. It seemed to bring the insects out last night - I had to turn the light off in the end as it sounded as if a swarm of insects were trying to break in through the mesh.  I hope the lizard that lives in the window had a good feed!



spotted this morning - chilling out on the
window pane

 A grasshopper managed to get into the house - think he was sheltering out of the rain.  These particular grasshoppers are a delicacy here - they are deepfried and eaten.  Not much meat on one but I bet it tastes like chicken!  Being a veggie I'm not inclined to seek these out to try... they are bright green and about 3 inches long.  I haven't seen one jump....yet.....


last night - newly arrived






Went for a swim on the weekend up to the Mount Elgon Hotel.  There was a great view down into the low land and of Mount Elgon itself.  Saturday was a much warmer and sunnier day than yesterday so it was nice to get into the outdoor pool. I also had it all to myself too.  By the time I'd come back to the pool area after a massage (v nice) the pool had filled up with kids - so I think I timed it well!

Just found out we have a public holiday this week to celebrate the end of Ramadan.  That makes up for working on Bank Holiday Monday!  Even though Uganda isn't an Islamic country it is one of the most popular religions here.  In Uganda most people are Christian and keenly practice their religion - however other key religions are recognised hence the day off for Eid ul Fitr.  There are quite a few Muslims in Mbale - there is an Islamic University here and a few mosques.

Fairly quiet this week - maybe life is slipping into a routine - not sure this is good.

It's been mostly business as usual around the hospital this week.  Last night was a bit noisy - they are building a new store room behind the guest house and plan to put a huge water tank on top.  I was a bit worried as the store room has a few openings at the front and is made mud bricks...the water tank will be v heavy.  A collapse and it would be heading straight for my room.  However reinforcement is underway - work with heavy machinery went on until about 9:00pm.  The sun set at 7.00pm and out came the odd lampbulb - I was quite impressed there were no accidents. Spot the hazards......



water tank on the right



It was the physiotherapists last day today, she's got  new job in a government hospital.  It was also the birthday of one of the lab techicians.  We had a little party at the end of the day for them.  Everyone had a soda (bottle of pop) and small cake (bit like sponge/brioche). Happy birthday was sung for Davis and he was made to do a dance.  Then there was a prayer, followed by people standing up and giving messages to the person who was leaving - what they'd liked about working with her and so on.  This was very nice.  The speeches were also quite short so it was lively.  She was also given a small present and did a short thank you speech.



Giving thaks



chilling out in the canteen

There has been some talk of the events in Libya. Uganda is one of the countries that still recognises Gaddafi as leader.  When I saw the news earlier there was a bit about France, Britain, Brazil, China, Russia etc meeting to discuss the situation. No mention of any African leaders nor the fact that African leaders are also meeting to discuss - they would still like to resolve matters using diplomatic means fearing a civil war.  It is interesting to see how the news is reported and plays out in different countries; also interesting is the apparent lack of engagment of African leaders - Gaddafi is after all one of the African elders.

Another week has flown by; need to get some plans sorted for the weekend - they've been on hold as I thought I may have had some time free next week for a bigger trip.  Working on a business case instead.
Halfway through now......at this rate I'll be back before I know it!

Quiet one this weekend.  Did boring but necessary chores like washing and ironing. Can't believe how stubborn some of the dirt is....it's red and gets everywhere.

Forgot to mention last week that I have been given an African name - Akot - it means comes with the rains.  This is quite appropriate as my arrival co-incided with the start of the rainy season, also I come from somewhere where it rains quite lot.  A name that fits me well I think. Most of the names I have come across have been names that are not unusual and many are biblical names.  One that threw me was Emma.  I was looking for a female doctor instead of a male doctor.  Here Emma is a common name for men as it is short for Emmauel and not used at all as a name for females.  I won't be making that mistake again.

One of things that has surprised me since I've been here is how strong the sense of tribe is.  It is something that seems to define everyday life for Ugandans.  You can often tell from people's names which tribe they come from. My African name above is from the local tribe. People often define themselves by their tribe.  The languges are also different - which is why people from different areas sometimes can't communicate if they don't speak English.  Apparently there are also physical characteristics that typify some tribes.  I've been told that there is a hierarchy of tribes, those belonging to the tribe that is in power thinking that they are better than other tribes.  Also the cabinet tends to be made up of those from the same tribe as their leader; and apparently more spending/ contracts etc go to those of the tribe of the ruling party.   So it seems that even if there is a change in goverment unless there is some sort of equality of tribes there can never really be democracy. And of course, tribes also span across national borders.

As it's been a quiet weekend this is a much shorter update....until the next time

Ah, another day at the office.  That's another week gone by in a flash.  Super focused today; we're going to have a staff meeting next Friday for me to go through my findings, observations and suggested actions.  This is positive.

Someone has also offered to take me out on a home visit.  If the patients don't turn up for their follow up appointments then the social worker may undertake a home visit.  We're going to do a local one - this is good as some of the journeys sound like intrepid treks. The social worker didn't get home unto 1.30am this week after getting soaked (rain) and having to hitch a lift back on a cart as there was no transport at all.  Although there are big buses connecting the major towns and taxi-buses connecting other main routes outside this, it's boda bodas (motor bikes), then bicycles and then ? whatever comes along - if anything.

There was a parents support group meeting here today.  About 50-odd parents who have been through the hopsital came along, with their children.  They have education classes, the children get to play with each other and associate with others who may have similar disabilities.  It also shows mothers who have children admitted in the hospital that their child can survive and can live a normal life.  Well, I walked past on the way to lunch - I couldn't believe how much mess the kids could make in so little time. There was one little boy who had spina bifida and who was a  bit knock-kneed who was racing about the place.  fter lunch I joined him and his friend (below) for a game of catch - I had to throw the ball very precisely as their balance wasn't the best - they however liked to give me a bit of a runaround now and again!  There was a child with hydrocephalus watching - he was funny as he screamed and laughed hysterically everytime I had to stretch out for the ball!

Have learnt today about a rather random bug.  I have no idea what it is called and wouldn't have known it was even a bug if someone hadn't told me.  Here it is

It looks like a bit of paper; but apparently creates mould - particularly on walls.  It also jumps about 6 inches when it's dark.  Wierd.

Happy birthday Jem

Time for the weekend....



Internet has been running slower than a slow thing lately.  Patience......Talking of slow things here is a snail I spotted the other day when I was walking to work in the rain, it's about 4 inches long

Forgot to mention the fashions in my last update.  The ladies, mostly outside the town, wear very colourful outfits with very pointy shoulders - sometimes rising quite a few inches above shoulder height. They look very graceful as they are walking along.  The shoulder designs look like a feat of engineering.

Had some drama last night.  Got back from town (I'd ventured into the fruit and veg part of the market this time) and it suddendly sounded as if it was pouring down with rain.  If only.....a water pipe had burst in Dr Shabani's bedroom and water was flooding out - by the time the head of maintenance had been tracked down and the stop cock had been located (noted for future reference) 3 bedrooms had been flooded and most of the main sitting room.  Shabani had created a bit of  damn to try to stop the water flooding out of his room.  Much of the evening was spent on clean up - dustpan was v effective in scooping up water!  Some of the guest house is now without water - I'm lucky - I had water and didn't get flooded.  Who knows what will be available later...

Bit of controversy here at the moment over a local forest.  There are government proposals to give some of the land to a private company to grow sugar cane.  It said that the land was deforested however when MPs went on a fact finding mission they discovered the land was still forested!  There are acres and acres of sugar cane grown here - plans to chop down an important forest to grow sugar cane seem like madness - particuarly when there is uncultivated land elsewhere.  They've been experiencing land slides near here and people have been killed  these are likely to have been exacerbated by deforestation.

There was a (peaceful) protest in Kampala against the government yesterday.  Protesters were soaked with pink water and dispersed......

Was on the ward this morning finding out a bit more about the work of the nurses.  There was a boy who had come back after surgery.  He was given morphine because he was in such pain.  He had a very big brain tumour which should have been operated on years ago.  After surgery all the side of his head was swollen - he couldn't really open his eye, he was in a right state poor thing.  He was with his grandmother who was very worried about him, however people all over Uganda speak different languages and so can't always converse with each other unless they can speak English.  It must be quite frightening being so worried and not knowing what exactly is happening because you cannot communicate.

I also saw Dick being brought back from surgery. I think he suffers a lot with fits.  Here's a photo of Dick I took earlier in the week.  He was eating a lolly and didn't know his tongue had gone blue so I took a photo to show him.  He was quite weak when he came back to the ward as he'd up most of the night vomitting - he still managed to raise me a little smile though.

Nearly finished my initial report - I've a meeting  (hopefully) with the Medical Director tomorrow so should hopefully be able to finalise it and work out what I'm going to do next. I've been looking at information flows within the hospital, working out the high level process - from the time a patient registers to when they go out the other end and have follow up appointments - and mapping what happens in terms of information during this process.  It seems a patients name and no is recorded at least 30 times during a stay.....The report identifies potential issues and improvement actions.  I'm also producing a framework in terms of how the information could be logically stored which they can use if they implement an electronic system..

Jinja town, lake Victoria in the background



Nile at Bujagali Falls




More of the powerful Nile




Me, Dr Sam and Dr Shabani on an island in the middle of the Nile reached by a small wooden boat..